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Vanderbilt Audiology Journal Club: A Vestibular Update

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1.  The current authors are suggesting that the patient's depersonalization symptom stemmed from an impairment affecting which of the following parts of the peripheral vestibular system: The horizontal semicircular canal The anterior canal cupula The otolith end organs bilaterally The otolith end organs on the left side only

2.  Results of functional imaging suggest that areas associated with integrating visuomotor and vestibular system information reside in the: frontal cortex occipital cortex corona radiata temporo-parietal cortex

3.  Precipitating factors for depersonalization include all of the below with the exception of: anxiety stress use of hallucinogenics heart rate

4.  Patients that have Meniere's disease: are most likely to have no gain on vHIT are most likely to have normal gain on vHIT and abnormal caloric testing are most likely to have normal gain on vHIT, but always have abnormal rotational chair testing are most likely to have normal gain on vHIT, but always have abnormal overt saccades

5.  Why would VOR gain for vHIT and calories conflict for patients with Meniere's disease? The size of the endolymphatic space affects calorics but not vHIT Type II hair cells and nerve fibers that are most responsive to low frequencies The canal diameter affects calorics but not vHIT Potentially a combination of answers from A, B and C

6.  If we suspect Meniere's disease, we should test: VEMP, vHIT and calorics vHIT only Calorics only VEMPs only

7.  Which of the following nystagmus characteristics were associated with canalithiasis horizontal canal BPPV? Geotropic Nystagmus Asymmetric Peak Slow Phase Velocity Reduction in Slow Phase Velocity to 1.8% at 40 seconds All of the above

8.  Which of the following nystagmus characteristics were associated with cupulolithiasis horizontal canal BPPV? Reduction in Slow Phase Velocity to 1.8% at 40 sec Symmetric Peak Slow Phase Velocity Agetropic Nystagmus Reversal of Nystagmus in Single Test Position

9.  Compared to cupulolithiasis and canalithiasis variants of horizontal canal BPPV, patients with vestibular migraine tended to have what nystagmus slow phase velocity pattern? Asymmetric nystagmus intensity greater with affected ear down Asymmetric nystagmus intensity greater with unaffected ear down Asymmetric nystagmus intensity greater with unaffected ear up Symmetric nystagmus intensity regardless of which ear was positioned up or down

10.  In Lechner et al (2014) what was the most common diagnosis among their 20 patients with horizontal positional nystagmus who did not have BPPV? Vestibular Migraine Meniere's Disease Vestibular Schwannoma Vestibular Neuritis